professional membership application form experience … · 2017-10-13 · australian restructuring...
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ARITA ACN 002 472 362
Level 5, 191 Clarence Street, Sydney NSW 2000 Australia | GPO Box 4340, Sydney NSW 2001 t +61 2 8004 4344 | e [email protected] | arita.com.au
AUSTRALIAN RESTRUCTURING INSOLVENCY & TURNAROUND ASSOCIATION
Lender & Investor Member Graduate Member Student Member
DD/MM/YY
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY
Number of years’ experience in Restructuring, Insolvency & Turnaround (Note: must be greater than 10 years to be eligible for entry with Experience pathway)
Last Name Designation
Position Gender Date of Birth
Company
Business Street Address
Business Postal Address
Private Address
Preferred Postal Address
Phone Fax Mobile
Email Address
Secondary Email Address
Member ID Year Graduated IEP or Advanced Certification
Current Membership Category
Title First Name Middle Name(s)
Business Street Business Postal Private
Associate Member Academic Member
Number of years in other Please specify areas
Number of years in other Please specify areas
What is your main focus or area of expertise?
PROFESSIONAL EXPERIENCE
YOUR DETAILS
ARITA DETAILS
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 1 OF 6
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ARITA ACN 002 472 362
Level 5, 191 Clarence Street, Sydney NSW 2000 Australia | GPO Box 4340, Sydney NSW 2001 t +61 2 8004 4344 | e [email protected] | arita.com.au
AUSTRALIAN RESTRUCTURING INSOLVENCY & TURNAROUND ASSOCIATION
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 2 OF 6
Current Employer Commencement Date
Previous Employer
Period of Employment to Position
Previous Employer
Period of Employment to Position
EMPLOYMENT HISTORY
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Institute Year of Completion
Name of Qualifications / Degree
Institute Year of Completion
Name of Qualifications / Degree
Institute Year of Completion
Name of Qualifications / Degree
Chartered Accountants (CAANZ) Category Current To
CPA Australia (CPA) Category Current To
Law Society / Institute Category Current To
Practicing Certificate Category Current To
Other Issued By Current To
Other Issued By Current To
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DD/MM/YY
DD/MM/YY
DD/MM/YY
DD/MM/YY
DD/MM/YY
DD/MM/YY
DD/MM/YY
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EDUCATION HISTORY
PROFESSIONAL BODY
Registered Liquidator No. Date registered Current To
Official Liquidator No. Date Registered Current To
Trustee No. Date Registered Current To
REGISTRATIONS / /
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DD/MM/YY / /
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Why should you be admitted as a member? Please explain below
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ARITA ACN 002 472 362
Level 5, 191 Clarence Street, Sydney NSW 2000 Australia | GPO Box 4340, Sydney NSW 2001 t +61 2 8004 4344 | e [email protected] | arita.com.au
AUSTRALIAN RESTRUCTURING INSOLVENCY & TURNAROUND ASSOCIATION
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 3 OF 6
CV / Resume / Bio with detailed experience including CPD details
Proof of Employment letter
Letter(s) of Good Standing from your Association(s)
Qualifications documentations (transcripts, certificates etc)
Letter from Chairman, CEO or Regional Leader or equivalent
Experience Reference Letters (minimum of 2)
Character Reference Letter
Professional Indemnity Insurance Cover
Others, please specify
Please send me the ARITA Annual Report electronically or
Please send me the ARITA Annual Report in print form
I declare the above information and supporting documentations I have provided are true and accurate records.
I know of no reasons why I should not be admitted as a Member of ARITA.
I agree to be bound by the ARITA Constitution and Regulations, including the Code of Professional Practice.
I confirm that I am not currently the subject of disciplinary proceedings by an insolvency regulator or a relevant professional body (other than ARITA) or if I am subject to disciplinary proceedings by an insolvency regulator or a relevant professional body (other than ARITA) details have been forwarded to ARITA on a confidential basis. ARITA may contact you further regarding information provided in relation to disciplinary proceedings, including any consequential impact on your membership application.
I note that visitors to the ARITA website will be able to search my current membership status, registered firm name and business contact details and I release ARITA to provide this information.
I agree that ARITA can provide my Employer, Regulator and/or Foundation Body with information relating to my membership.
I give consent for ARITA to provide my membership details to INSOL International for membership and including for publication in the INSOL directory.
I confirm that I am covered either individually or through my firm/employer with adequate fidelity / professional indemnity insurance to undertake the scope of professional services that I provide.
I confirm that I have completed at least 40 hours of job relevant CPD in the last 12 months (at least 10 hours must be verifiable, the rest can be made up of non-verifiable hours).
Two references are required for all applications. Your two referees must be current ARITA Professional Members and at least one must be from other firm other than your current one. Both must have known you for one year or longer.
The forms for your referees to complete are at the end of this application form.
SUPPORTING DOCUMENTATION (Required)
ARITA ANNUAL REPORT PUBLICATION Please nominate your preferred delivery method
COMPULSORY DECLARATIONS
REFERENCE CHECKS
ARITA ACN 002 472 362
Level 5, 191 Clarence Street, Sydney NSW 2000 Australia | GPO Box 4340, Sydney NSW 2001 t +61 2 8004 4344 | e [email protected] | arita.com.au
AUSTRALIAN RESTRUCTURING INSOLVENCY & TURNAROUND ASSOCIATION
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 1 OF 3PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 4 OF 6
I confirm that I remain a member in good standing of the relevant Foundation accounting body or Law society or Institute, or that I continue to hold a legal Practising Certificate.
NON-COMPULSORY DECLARATION
Signature
Date DD/MM/YY / /
All membership applications are put through a rigorous screening process including approval by the local Division Committee from which the applicant resides and then by the ARITA Board.
All membership applications should be sent through as one complete document (less than 2MB) and must have all supporting documentation.
Membership applicants may be interviewed by their local Division Committee representative(s) or the National Membership Committee prior to their application being approved.
Applications can be expected to take 2 - 3 months to complete this process. Please return your completed application form and all supporting documentation scanned by email to [email protected]
PROCESSING TIME
ARITA ACN 002 472 362
Level 5, 191 Clarence Street, Sydney NSW 2000 Australia | GPO Box 4340, Sydney NSW 2001 t +61 2 8004 4344 | e [email protected] | arita.com.au
AUSTRALIAN RESTRUCTURING INSOLVENCY & TURNAROUND ASSOCIATION
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 5 OF 6
Company Member ID
Company Member ID
Phone
Relationship Known
I support and recommend the above mentioned applicant for membership of ARITA. I confirm that I am not related to the applicant and that I have known or worked with the applicant for more than one year.
Title First Name Last Name
Title First Name Last Name
Applicant’s Details
Proposer #1
Signature
Date DD/MM/YY / /
REFERENCE #1
ARITA ACN 002 472 362
Level 5, 191 Clarence Street, Sydney NSW 2000 Australia | GPO Box 4340, Sydney NSW 2001 t +61 2 8004 4344 | e [email protected] | arita.com.au
AUSTRALIAN RESTRUCTURING INSOLVENCY & TURNAROUND ASSOCIATION
PROFESSIONAL MEMBERSHIP APPLICATION FORM EXPERIENCE PATHWAY: PAGE 6 OF 6
Company Member ID
Company Member ID
Phone
Relationship Known
I support and recommend the above mentioned applicant for membership of ARITA. I confirm that I am not related to the applicant and that I have known or worked with the applicant for more than one year.
Title First Name Last Name
Title First Name Last Name
Applicant’s Details
Proposer #2
Signature
Date DD/MM/YY / /
REFERENCE #2